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Bovonsunthonchai S, Witthiwej T, Vachalathiti R, Hengsomboon P, Thong-On S, Sathornsumetee S, Ngamsombat C, Chawalparit O, Muangpaisan W, Richards J. Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus. Sci Rep 2024; 14:2053. [PMID: 38267518 PMCID: PMC10808249 DOI: 10.1038/s41598-024-52516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/19/2024] [Indexed: 01/26/2024] Open
Abstract
Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological condition that often presents gait disturbance in the early stages of the disease and affects other motor activities. This study investigated changes in temporospatial gait variables after cerebrospinal fluid (CSF) removal using a spinal tap test in individuals with idiopathic normal pressure hydrocephalus (iNPH), and explored if the tap test responders and non-responders could be clinically identified from temporospatial gait variables. Sixty-two individuals with iNPH were recruited from an outpatient clinic, eleven were excluded, leaving a total of 51 who were included in the analysis. Temporospatial gait variables at self-selected speed were recorded at pre- and 24-h post-tap tests which were compared using Paired t-tests, Cohen's d effect size, and percentage change. A previously defined minimal clinical important change (MCIC) for gait speed was used to determine the changes and to classify tap test responders and non-responders. A mixed model ANOVA was used to determine the within-group, between-group, and interaction effects. Comparisons of the data between pre- and post-tap tests showed significant improvements with small to medium effect sizes for left step length, right step time, stride length and time, cadence, and gait speed. Gait speed showed the largest percentage change among temporospatial gait variables. Within-group and interaction effects were found in some variables but no between-group effect was found. Tap test responders showed significant improvements in right step length and time, stride length and time, cadence, and gait speed while non-responders did not. Some individuals with iNPH showed clinically important improvements in temporospatial gait variables after the tap test, particularly in step/stride length and time, cadence, who could be classified by gait speed. However, gait-related balance variables did not change. Therefore, additional treatments should focus on improving such variables.
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Affiliation(s)
| | - Theerapol Witthiwej
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | | | | | - Sith Sathornsumetee
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Faculty of Medicine Siriraj Hospital, NANOTEC-Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Mahidol University, Bangkok, Thailand
| | - Chanon Ngamsombat
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orasa Chawalparit
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerasak Muangpaisan
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
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Bovonsunthonchai S, Vachalathiti R, Hiengkaew V, Bryant MS, Richards J, Senanarong V. Quantitative gait analysis in mild cognitive impairment, dementia, and cognitively intact individuals: a cross-sectional case-control study. BMC Geriatr 2022; 22:767. [PMID: 36151524 PMCID: PMC9502583 DOI: 10.1186/s12877-022-03405-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cognitive age-related decline is linked to dementia development and gait has been proposed to measure the change in brain function. This study aimed to investigate if spatiotemporal gait variables could be used to differentiate between the three cognitive status groups. Methods Ninety-three older adults were screened and classified into three groups; mild cognitive impairment (MCI) (n = 32), dementia (n = 31), and a cognitively intact (n = 30). Spatiotemporal gait variables were assessed under single- and dual-tasks using an objective platform system. Effects of cognitive status and walking task were analyzed using a two-way ANCOVA. Sub-comparisons for between- and within-group were performed by one-way ANCOVA and Paired t-tests. Area Under the Curve (AUC) of Receiver Operating Characteristics (ROC) was used to discriminate between three groups on gait variables. Results There were significant effects (P < 0.05) of cognitive status during both single and dual-task walking in several variables between the MCI and dementia and between dementia and cognitively intact groups, while no difference was seen between the MCI and cognitively intact groups. A large differentiation effect between the groups was found for step length, stride length, and gait speed during both conditions of walking. Conclusions Spatiotemporal gait variables showed discriminative ability between dementia and cognitively intact groups in both single and dual-tasks. This suggests that gait could potentially be used as a clinical differentiation marker for individuals with cognitive problems.
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Affiliation(s)
| | | | - Vimonwan Hiengkaew
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Mon S Bryant
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston, UK
| | - Vorapun Senanarong
- Division of Neurology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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3
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Ferrari A, Milletti D, Palumbo P, Giannini G, Cevoli S, Magelli E, Albini-Riccioli L, Mantovani P, Cortelli P, Chiari L, Palandri G. Gait apraxia evaluation in normal pressure hydrocephalus using inertial sensors. Clinical correlates, ventriculoperitoneal shunt outcomes, and tap-test predictive capacity. Fluids Barriers CNS 2022; 19:51. [PMID: 35739555 PMCID: PMC9219204 DOI: 10.1186/s12987-022-00350-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is a neurological condition with gait apraxia signs from its early manifestation. Ventriculoperitoneal shunt (VPS) is a surgical procedure available for treatment. The Cerebrospinal fluid Tap Test (CSF-TT) is a quick test used as selection criterion for VPS treatment. Its predictive capacity for VPS outcomes is still sub judice. This study is aimed to test the hypothesis that wearable motion sensors provide valid measures to manage iNPH patients with gait apraxia. METHODS Forty-two participants of the Bologna PRO-Hydro observational cohort study were included in the analyses. The participants performed the Timed Up and Go (TUG) and the 18 m walking test (18mW) with inertial sensors at baseline, three days after the CSF-TT, and six months after VPS. 21 instrumental variables described gait and postural transitions from TUG and 18mW recordings. Furthermore, participants were clinically assessed with scales (clinical variables). We tested the hypothesis by analysing the concurrent validity of instrumental and clinical variables, their individual- and group-level responsiveness to VPS, and their predictive validity for VPS outcomes after CSF-TT. RESULTS The instrumental variables showed moderate to high correlation with the clinical variables. After VPS, most clinical and instrumental variables showed statistically significant improvements that reflect a reduction of apraxic features of gait. Most instrumental variables, but only one clinical variable (i.e., Tinetti POMA), had predictive value for VPS outcomes (significant adjusted R2 in the range 0.12-0.70). CONCLUSIONS These results confirm that wearable inertial sensors may represent a valid tool to complement clinical evaluation for iNPH assessment and prognosis.
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Affiliation(s)
- Alberto Ferrari
- Science & Technology Park for Medicine, TPM, Mirandola, Modena, Italy.,Department of Engineering "Enzo Ferrari", University of Modena and Reggio Emilia, Modena, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - David Milletti
- Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital Via Altura 3, 40139, Bologna, Italy.
| | - Pierpaolo Palumbo
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Cevoli
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elena Magelli
- Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital Via Altura 3, 40139, Bologna, Italy
| | - Luca Albini-Riccioli
- Unit of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Mantovani
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy.,Health Sciences and Technologies Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Giorgio Palandri
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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He M, Qi Z, Shao Y, Yao H, Zhang X, Zhang Y, Shi Y, E Q, Liu C, Hu H, Liu J, Sun X, Wang Z, Huang Y. Quantitative Evaluation of Gait Changes Using APDM Inertial Sensors After the External Lumbar Drain in Patients With Idiopathic Normal Pressure Hydrocephalus. Front Neurol 2021; 12:635044. [PMID: 34305775 PMCID: PMC8296837 DOI: 10.3389/fneur.2021.635044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Gait and balance disturbances are common symptoms of idiopathic normal pressure hydrocephalus (iNPH). This study aimed to quantitatively evaluate gait and balance parameters after external lumbar drainage (ELD) using APDM inertial sensors. Methods: Two-minute walkway tests were performed in 36 patients with suspected iNPH and 20 healthy controls. A total of 36 patients underwent ELD. According to clinical outcomes, 20 patients were defined as responders, and the other 16 as non-responders. The gait parameters were documented, and the corresponding differences between responders and non-responders were calculated. Results: When compared with healthy controls, patients with suspected iNPH exhibited decreased cadence, reduced gait speed, a higher percentage of double support, decreased elevation at mid-swing, reduced foot strike angle, shorter stride length, difficulty in turning, and impaired balance functions. After the ELD, all these manifestations, except elevation at mid-swing and balance functions, were significantly improved in responders. The change of Z-score absolute value in the six parameters, except for foot strike angle, was >1. No significant improvement was observed in non-responders. Conclusion: APDM inertial sensors are useful for the quantitative assessment of gait impairment in patients with iNPH, which may be a valuable tool for identifying candidates that are suitable for shunting operations.
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Affiliation(s)
- Mengmeng He
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Neurosurgery, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, China
| | - Zhenyu Qi
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yunxiang Shao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui Yao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuewen Zhang
- Department of Neurosurgery, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, China
| | - Yang Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Shi
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qinzhi E
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chengming Liu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongwei Hu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiangang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoou Sun
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yulun Huang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Neurosurgery, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, China
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Hnin HH, Bovonsunthonchai S, Witthiwej T, Vachalathiti R, Ariyaudomkit R. Feasibility of action observation effect on gait and mobility in idiopathic normal pressure hydrocephalus patients. Dement Neuropsychol 2021; 15:79-87. [PMID: 33907600 PMCID: PMC8049582 DOI: 10.1590/1980-57642021dn15-010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Action observation (AO) has been proved to be of benefit in several neurological
conditions, but no study has previously been conducted in idiopathic normal
pressure hydrocephalus (iNPH).
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Affiliation(s)
- Htet Htet Hnin
- Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand
| | - Sunee Bovonsunthonchai
- Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand
| | - Theerapol Witthiwej
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University - Bangkok, Thailand
| | | | - Rattapha Ariyaudomkit
- Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University - Nakhon Pathom, Thailand
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Rojasavastera R, Bovonsunthonchai S, Hiengkaew V, Senanarong V. Action observation combined with gait training to improve gait and cognition in elderly with mild cognitive impairment A randomized controlled trial. Dement Neuropsychol 2020; 14:118-127. [PMID: 32595880 PMCID: PMC7304276 DOI: 10.1590/1980-57642020dn14-020004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Owing to advancement of medical technology and current knowledge, the population has a longer life expectancy, leading to an increase in the proportion of elderly.
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Affiliation(s)
- Rommanee Rojasavastera
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Sunee Bovonsunthonchai
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.,Gait and Balance Group, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Vimonwan Hiengkaew
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Vorapun Senanarong
- Division of Neurology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Ferrari A, Milletti D, Giannini G, Cevoli S, Oppi F, Palandri G, Albini-Riccioli L, Mantovani P, Anderlucci L, Cortelli P, Chiari L. The effects of cerebrospinal fluid tap-test on idiopathic normal pressure hydrocephalus: an inertial sensors based assessment. J Neuroeng Rehabil 2020; 17:7. [PMID: 31948485 PMCID: PMC6966881 DOI: 10.1186/s12984-019-0638-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 12/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background Gait disturbances are typical of persons with idiopathic normal pressure hydrocephalus (iNPH) without signs distinctive from other neurodegenerative and vascular conditions. Cerebrospinal fluid tap-test (CSF-TT) is expected to improve the motor performance of iNPH patients and is a prognostic indicator in their surgical management. This observational prospective study aims to determine which spatio-temporal gait parameter(s), measured during instrumented motor tests, and clinical scale(s) may provide a relevant contribution in the evaluation of motor performance pre vs. post CSF-TT on iNPH patients with and without important vascular encephalopathy. Methods Seventy-six patients (20 with an associated vascular encephalopathy) were assessed before, and 24 and 72 h after the CSF-TT by a timed up and go test (TUG) and an 18 m walking test (18 mW) instrumented using inertial sensors. Tinetti Gait, Tinetti Balance, Gait Status Scale, and Grading Scale were fulfilled before and 72 h after the CSF-TT. Stride length, cadence and total time were selected as the outcome measures. Statistical models with mixed effects were implemented to determine the relevant contribution to response variables of each quantitative gait parameter and clinical scales. Results and conclusion From baseline to 72 h post CSF-TT patients improved significantly by increasing cadence in 18 mW and TUG (on average of 1.7 and 2.4 strides/min respectively) and stride length in 18 mW (on average of 3.1 cm). A significant reduction of gait apraxia was reflected by modifications in double support duration and in coordination index. Tinetti Gait, Tinetti Balance and Gait Status Scale were able to explain part of the variability of response variables not covered by instrumental data, especially in TUG. Grading Scale revealed the highest affinity with TUG total time and cadence when considering clinical scales alone. Patients with iNPH and an associated vascular encephalopathy showed worst performances compared to pure iNPH but without statistical significance. Gait improvement following CSF-TT was comparable in the two groups. Overall these results suggest that, in order to augment CSF-TT accuracy, is key to assess the gait pattern by analyzing the main spatio-temporal parameters and set post evaluation at 72 h. Trial registration Approved by ethics committee: CE 14131 23/02/2015.
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Affiliation(s)
- Alberto Ferrari
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - David Milletti
- Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Giannini
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federico Oppi
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giorgio Palandri
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Albini-Riccioli
- Unit of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Mantovani
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Laura Anderlucci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Pietro Cortelli
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Lorenzo Chiari
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
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